CAJ | 학술논문

目的探讨输尿管软镜下钬激光碎石在输尿管上段结石伴肾功能不全患者中应用的有效性和安全性.方法回顾性分析了2012年12月至2014年2月间,采用输尿管软镜下钬激光碎石术治疗输尿管上段结石伴肾功能不全患者19例,年龄28～72岁,平均55岁,经腹部平片(KUB)、CT平扫确诊为输尿管上段结石,结石直径约8～12mm(平均10.1mm).所有患者一期先在局麻下行患侧双J管内置术,置管2～4周后行输尿管软镜下钬激光碎石.术后留置双J管2～4周.术后1～2d、1个月和3个月复查腹平片或泌尿系超声或CT,观察是否有残留结石,血清肌酐(Cre)评判肾功能变化.结果所有患者一期局麻下留置双J管成功,输尿管软镜均顺利进镜,一次碎石成功.手术时间为36～ 85 min,平均时间58.6min.术后住院天数3～10d,平均6d.术后2d排石率为52.6％(10/19),术后1个月排石率为84.2％(16/19),术后3个月排石率为94.7％(18/19).输尿管软镜钬激光碎石术前最低血清肌酐水平155 ～ 590.8μmol/L,平均为243.6μmol/L.2例患者输尿管软镜术后出现肾功能不全情况较术前升高,术后6d恢复至术前水平,其余患者术后血清肌酐较术前逐渐下降,但仍高于正常值.本组术中及术后未出现重大并发症.5例术后出现发热大于38℃,经积极治疗后恢复正常.结论输尿管上段结石伴肾功能不全患者,实施输尿管软镜下钬激光碎石的手术风险高,采用一期局麻下行双J管内引流术做好术前准备,二期输尿管软镜下钬激光碎石术,其疗效满意,安全性可靠.
목적 탐토수뇨관연경하화격광쇄석재수뇨관상단결석반신공능불전환자중응용적유효성화안전성.방법 회고성분석료2012년12월지2014년2월간,채용수뇨관연경하화격광쇄석술치료수뇨관상단결석반신공능불전환자19례,년령28～72세,평균55세,경복부평편(KUB)、CT평소학진위수뇨관상단결석,결석직경약8～12mm(평균10.1mm).소유환자일기선재국마하행환측쌍J관내치술,치관2～4주후행수뇨관연경하화격광쇄석.술후류치쌍J관2～4주.술후1～2d、1개월화3개월복사복평편혹비뇨계초성혹CT,관찰시부유잔류결석,혈청기항(Cre)평판신공능변화.결과 소유환자일기국마하류치쌍J관성공,수뇨관연경균순리진경,일차쇄석성공.수술시간위36～ 85 min,평균시간58.6min.술후주원천수3～10d,평균6d.술후2d배석솔위52.6％(10/19),술후1개월배석솔위84.2％(16/19),술후3개월배석솔위94.7％(18/19).수뇨관연경화격광쇄석술전최저혈청기항수평155 ～ 590.8μmol/L,평균위243.6μmol/L.2례환자수뇨관연경술후출현신공능불전정황교술전승고,술후6d회복지술전수평,기여환자술후혈청기항교술전축점하강,단잉고우정상치.본조술중급술후미출현중대병발증.5례술후출현발열대우38℃,경적겁치료후회복정상.결론 수뇨관상단결석반신공능불전환자,실시수뇨관연경하화격광쇄석적수술풍험고,채용일기국마하행쌍J관내인류술주호술전준비,이기수뇨관연경하화격광쇄석술,기료효만의,안전성가고.
Objectives To evaluate the efficacy and safety of flexible ureteroscopic holmium laser lithotripsy for proximal ureteral calculi in the patients with renal insufficiency.Methods Between December 2012 and February 2014,A total of 19 patients,with a mean age of 55 years (range 28 ～72),underwent flexible ureteroscopic holmium:YAG laser lithotripsy for proximal ureteral calculi with renal insufficiency,patients were examined by kidney-ureter-bladder abdominal radiography and abdominal computed tomography (CT),The average size of the stones treated was 10.1 mm(range 8～12 mm) in diameter,Internal ureteral stenting (double J stent) was performed firstly,Secondary procedures (flexible ureteroscope holmium laser lithotripsy)were performed in 2 ～4 weeks later,Double J stent was removed in 2 ～4 weeks.Residual stones were examined by abdominal plain film or urinary tract ultrasound or urinary CT on the first or second post?operative days,1 months and 3 months respectively.the serum creatinine level was used as a marker of renal function.Results The average operation time was 58.6 minutes (range 36-85minutes),The average hospital stay was 6 days (range 3 ～ 10days),The stone-free rate was 52.6％ (10/19),84.2％ (16/19),94.7％ (18/19) in postoperatively 2 days,1 month,3 month respectively.the lowest serum creatinine level is 155 ～ 590.8 μmol/L(average was 243.6 μmol) before Flexible ureteroscope lithotripsy.serum creatinine level increased in 2 cases after operation,and it returned to the preoperative level in postoperative 6 days,serum creatinine level gradually improvement in all other cases,but still higher than normal value.There were no major complications.Postoperative fever ＞38℃ occurred in five cases and recovered after intravenous administration of antibiotics.Conclusions The operation risk is higher in the proximal ureteral calculi patients with renal insufficiency,Ureteral stent placement under local anesthesia for obstructing stones firstly and flexible ureteroscopic holmium:YAG laser lithotripsy are safe and efficacious.